The critical role librarians play in the opioid crisis Chera Kowalski
When you walk into your
neighborhood public library,
you expect the librarian
to help you find your next favorite book
or some accurate information
on a topic at interest.
You don’t probably expect the librarian
to come running out from behind
the reference desk with Narcan,
ready to revive someone
overdosing on heroin or fentanyl.
But this is happening at some libraries.
Public libraries have always been
about community support
with all kinds of services and programs
from assisting with job seeking efforts
to locating resources for voter rights
to providing free meals
to kids and teens even.
But what we think of as community support
takes on new urgency
when you’re in the middle
of an opioid and overdose crisis.
I work at the McPherson Square Library
of the Free Library of Philadelphia.
It’s located in Kensington,
one of the lowest income
communities in Philadelphia,
with a long history of being isolated
from resources and opportunity.
And because of that,
it has been the center to the city’s
drug trade and drug use for decades.
And so inside the neighborhood,
our library is nestled inside of a park,
which has unfortunately
garnered a reputation
for being a place to find and use drugs,
especially heroin,
out in the open,
putting us and the community
in direct contact
with the drug trade
and use on a daily basis.
And so inside the library,
it is routine to see people
visibly intoxicated on opioids:
eyes closing, body swaying slowly.
It is routine for me
to ask them if they are OK,
but at the same time remind them
if they can’t keep their eyes open,
they have to go.
It is routine for our volunteer, Teddy,
to pick up dozens of discarded needles
on our property and throughout the park.
And it is normal for kids
to come into the library
to tell me or our guard, Sterling,
that someone is outside using,
which typically means finding
someone injecting on our front steps,
benches
or near the building,
then asking them to move along
because kids see them.
And it is normal for the community
to see people in various states
of intoxication and withdrawal,
to see people buying and selling,
and to see people act and react violently.
I’m not sharing this
to sensationalize Kensington.
I’m sharing this because
this is the reality of a community
that is constantly striving
to move forward,
but due to factors like structural racism,
urban segregation,
the cyclical nature of poverty,
of trauma –
the community has inequitable access
to education, health care,
employment and more.
And this is also what it’s like
when the drug trade and use
affects every aspect
of life in the neighborhood.
And the opioid epidemic
has only amplified that stress.
When I was hired
by the Free Library in 2013,
I specifically chose to work at McPherson
because I understand what it’s like
to grow up in an environment
where substance use disorder
shapes the everyday,
and I wanted to use
those personal experiences
as a guide for my work.
But before I get to that,
I want to share what it was like
to witness this epidemic
grow in Kensington.
Like many other communities,
we were just not prepared.
We began to take notice
of IDs we were seeing:
addresses from nearby and upstate counties
and then slowly out-of-state ones.
People from Arkansas,
Ohio, South Carolina, Alabama
coming to Philadelphia for cheap heroin.
People began to linger longer
and longer in our public restroom,
causing us to pay
more attention to the restroom
than to our daily responsibilities
because it was an accessible place
to use drugs just purchased.
One day our toilet clogged
so badly in the restroom,
we were forced to close
our library for two days
because the culprit of the clog
was discarded needles.
For a while prior to that incident,
we had been asking for a sharps
container for the restroom,
and after that,
the library administration
quickly approved installing one
along with hiring bathroom monitors.
And as the weather warmed,
we struggled to respond.
People began camping out
in the park for days, weeks.
You could walk outside
on a sunny, warm day
to find multiple groups of people
in various states of intoxication
and children playing in between them.
The amount of needles collected
by Teddy on a monthly basis skyrocketed
from 100 to 300 to 500 to 800,
to over 1,000,
with many found on our front steps
and the playground.
Then there were the overdoses.
So many occurred outside in the park,
some inside the library.
Sterling, our guard, would spend his time
walking in and out of the building
and throughout the park,
constantly making sure everyone was safe,
because at times,
our fear of having someone
overdose and die came close.
One overdose in particular
occurred after school,
so the library was full of kids,
noise and commotion.
And in all of that,
we heard the thud
from inside the public restroom.
When we opened the door,
we found a man on the floor, unresponsive.
He was pulled out
in plain sight of everyone –
kids, teens, adults, families.
Someone on staff called 911,
someone else escorted the kids
and teens downstairs,
somebody went to flag down
the ambulance in the park.
And the rest of us –
we just waited.
This had become our overdose drill
because at the time,
it was all we could do.
So we waited and we watched
this man lose air –
seize up.
He was dying.
I don’t know how many of you
have witnessed an overdose on opioids,
but it’s horrific
because you know the gasping for air,
the loss of color in someone’s face,
is a timer running down
on the chances of this person surviving.
But luckily for this man,
the ambulance arrived
and he received a dose
of naloxone through injection.
And I remember he jolted
like he was electrocuted,
and he pulled the needle out,
and he told the paramedics to back off.
And then he stood up, and he walked out.
And we –
we went back to work
because people were still asking
for time on the computers,
kids still needed help with their homework
and this was our job –
our purpose.
I think that incident stays with me
because of the waiting.
It made me feel helpless.
And it was that feeling of helplessness
that reminded me so well of my childhood.
Before I was born,
both of my parents began using heroin.
It made our lives chaotic and unstable:
promises being made and constantly broken,
their fighting,
the weight of their secret –
the weight of our secret kept so much
so-called “normal” out of our lives.
Every time we’d be dropped off
at our grandparent’s house,
I’d be stuck on the thought
that I was never going to see them again.
Every time we’d be left in a car,
at a house, at a store,
I’d cry.
And every time I saw those El tracks –
the same ones I take
to work now to McPherson –
from the backseat of a car,
I’d be angry,
because even kids know
when their parents
are trying to score drugs.
There was so little I could do
to control what was going on around me,
that that feeling of helplessness
was overwhelming.
I struggled in school, struggled to read,
I was prone to anger and depression.
When I was 11 years old,
I started smoking,
which shortly after led to my own
experiences with drugs and alcohol.
I convinced myself that my parents' past
would be my future.
But eventually both of my parents
entered recovery
and maintained recovery from opioid use.
And their strength and their commitment
provided support and stability
for me and my siblings,
and it was those personal experiences
that brought me to McPherson.
Choosing to be a librarian
and choosing to be at McPherson
was me letting go
of that feeling of helplessness
and finding ways
to be supportive to others.
And one way to provide support
was learning how to administer Narcan.
Public libraries respond
to the needs of their communities,
and not knowing how to utilize Narcan
was a disservice
to the needs of our community.
We were on the frontlines
and desperately needed
access to this lifesaving tool.
So finally in late February of 2017,
after much advocating,
we finally received training
from Prevention Point Philadelphia
and about a month of so later,
I utilized Narcan for the first time
to save someone’s life.
It was after school again,
and Teddy came into the library
and said someone was overdosing
on a front bench.
Someone on staff called 911 again,
and I grabbed the Narcan kit.
The woman was barely in her 20s
and barely breathing.
Her friend was frantically
slapping her in the face
in hopes of reviving her.
I administered the Narcan nasally,
and thankfully she came to.
But before the ambulance arrived,
she and her friend ran off.
And when I finally turned around,
I saw the kids –
kids that come into the library
on a daily basis,
some that I have known for years –
standing on the steps of the building.
They saw everything.
And they didn’t seem
like they were visibly upset or in shock,
and so I walked into the building,
right into our workroom, and I cried.
I cried partly from the shock
of what just happened
because I never thought
I’d be saving anybody’s life ever,
but I mostly cried because of the kids.
This is their normal.
This is the community’s normal.
This is a catastrophic normal,
and in that moment,
I was forced to confront once again
that this should never be normal,
and as with my childhood,
when you’re in it, you just accept it.
The opioid epidemic
is not just about those living
with opioid use disorder
because the reach of the epidemic
goes well beyond those living with this
and their families.
It impacts the entire community.
Kensington was a community
in crisis before this
for reasons that are endemic
and intertwined,
and anyone familiar
with the neighborhood can think of why:
racial disparities,
failure of local and federal government
to properly fund schools,
lack of economic opportunity.
And what we’re trying to do at McPherson
is find ways to support
this community out of crisis.
And perhaps now, because of the epidemic,
more people are paying
attention to Kensington.
But regardless of that,
at McPherson,
we will continue to do what we can
with the resources we have
and we will continue to provide
whatever help we can
in hopes of keeping our community
safe and healthy
because public libraries
have always been more than just books.
We are physical shelter,
a classroom,
a safe haven,
a lunch room,
a resource hub
and yes,
even a lifeline.
Thank you.
(Applause)